Additional Information

FOR OFFICE USE ONLY Application No. Fees. Ref No.

Postgraduate Application Form

Apply Online: Please note that you now have the option to apply online instead of using this paper application form. For details please see http://pgapps.nottingham.ac.uk/
Please complete all questions in BLOCK CAPITALS in black ink and complete tick boxes as appropriate. We also require you to submit 2 references in sealed envelopes and all other supporting documentation before your application can be considered.

This form is available in alternative formats on request.

1 Programme Details Postgraduate Degree/Course (please state qualification and School for which you are applying)

(a) Research Degree (eg PhD, MPhil, DM, New Route PhD, EdD). Please state the degree subject

(b) Taught Postgraduate Course (eg masters degree/diploma/certificate) Please state full title as given in the University postgraduate prospectus

(c) In which School of the University do you intend to study? (Please refer to the prospectus for the correct School names)

Full-time

Part-time (tick one)

Proposed date of admission M M Y Y

2 Personal Details Title (Mr/Mrs/Miss/Ms/Dr) Surname/Family name

First/Given names

Date of Birth D D M M Y Y

Male

Female (tick one)

Correspondence Address Please note: this is the address to which the University will send all correspondence

Telephone number

Fax number

E-mail address

Postcode

From D D M M Y Y

To D D M M Y Y

Mobile number

Add permanent home address if different from above

Telephone number

Fax number

Mobile number

Postcode

From D D M M Y Y

To D D M M Y Y

E-mail address

3 Nationality and Residence details Nationality

Country of permanent residence

(a) Have you or your parents been resident in the UK for the past 3 years?

Yes

No

(b) If yes, was this solely for the purpose of education?

Yes

No

How do you intend to finance your studies? (Please tick as many as apply) Other (please specify) For fees purposes do you think you are (tick one) UK European Union

Self

Family

Employer

Sponsor

Channel Islands

International/non-EU

4 Academic History Higher education institutions attended and qualifications obtained or entered for (you must supply full dates). Please start with the most recent.

All applicants should enclose official transcripts of their qualifications.

Name & Address of Institution Dates of Attendance (date started and date awarded) Qualification and class of degree (if any) (Give Grade Point Average if applicable) Principal Subject(s) taken

Other information relevant to your academic history:

5 English Language Qualification(s) Is English your first language? Yes No

Is/was English the language of instruction for your first degree?

Yes

No

Score If English is not your first language please provide details of your English language qualifications with results obtained and the date you took the test or will be taking the test. IELTS TOEFL (paper version) TOEFL (computer version)

Date Obtained M M M M M M M M M M Y Y Y Y Y Y Y Y Y Y

You must provide a copy of your English language test score report with your application.

O level or GCSE Other (please specify)

6 References Please give the names of your two referees (please consult guidance notes). At least one should be from an academic member of staff at the institution where you gained your most advanced qualification Referee 1 Referee 2

Name

Name

Address

Address

Position

Position

Telephone number

Telephone number

Fax number

Fax number

E-mail address

E-mail address

7 Personal Statement (All applicants) Please use this space to summarise your academic interests and your reasons for choosing your intended course of study. You may continue on the back page if necessary.

(Research Applicants only) Please provide a brief outline of your proposed research topic or interests. If you have a detailed research proposal (not more than 2 pages) this may be attached. You should check the relevant school web site (http://www.nottingham.ac.uk/schools.phtml) regarding any specific guidelines on submitting your proposal.

Have you already made contact with a potential supervisor at Nottingham?

Yes

No

If yes, please give the name and School of the contact person at Nottingham:

Name

School

8 Career History Please give details of relevant employment and/or professional experience. Please start with the most recent. Continue on the back page or enclose a curriculum vitae if necessary. Date(s) Nature of work and position held (please specify whether post was full or part time) To M Y Y M M Y Y Name and address of employer

From M

From M M Y Y

To M M Y Y

From M M Y Y

To M M Y Y

9 How did you learn about the University of Nottingham and its programmes ?

Advertisement in Newspaper/Journal. Please name journal

Personal recommendation

Poster

British Council

Postgraduate Prospectus

Exhibition/Fair (UK)

Exhibition/Fair (Overseas)

Internet

Tutor

University Agent

School/Dept Brochure

Careers Office

Advertisement in Directory

University of Nottingham Postgraduate Open Day

Directory text entry Please name directory

Other (Please specify)

10 Disability, dyslexia or long-term medical condition The University of Nottingham aims to provide an environment in which all of our students are able to participate fully in university life. In order to assist us provide suitable support, please indicate if you have a disability. this will not affect judgements concerning your academic suitability for a course, and will be treated confidentially. None You are blind or partially sighted You use a wheelchair or have mobility difficulties You have a disability that cannot be seen, for example, diabetes, epilepsy or a heart condition You have a disability, special need or medical condition that is not listed above Further details/details about a disability not listed above You have a specific learning difficulty (for example dyslexia) You are deaf or impaired hearing You have mental health difficulties You have two or more of the above You have an Autistic Spectrum disorder/Asperger Syndrome

11 Criminal Convictions Do you have any criminal convictions (excluding motoring offences for which a fine and/or 3 penalty points were imposed) Yes No

12 Please check that your application is complete and that you have enclosed all the relevant documents Transcript of studies English language test score report (if English is not your first language) 2 references in signed and sealed envelopes Research proposal (if required)

The University collects information about its students for various academic, administrative, health and safety reasons. The information is processed in accordance with the 1998 Data Protection Act, and is disclosed to third parties only with the individuals consent or to meet a statutory obligation. The information provided on this application form will be stored electronically and used for administrative purposes by the University.

Declaration I certify that the information provided above is correct and I understand that the University will withdraw my application if any aspect is found to have been falsified. I consent to the processing of information provided on this form subject to the provisions of the Data Protection Act (1998).

Signature

Date

When completed please return to: The Postgraduate Admissions Office, Academic Office, E Floor, Portland Building, The University of Nottingham, University park, Nottingham NG7 2RD UK

FOR OFFICE USE ONLY Accept-Unconditional Accept-Conditional Conditions Reject

Supervisor(s)/Course Organiser (please use capitals)

Initial registration for the degree of:

Proposed thesis title or general area of research

Bench fee (If applicable)

Interviewed

Signed

Date

for the Head of Department